Sundt Incident Report

This is the mandatory form that must be completed for incidents on Sundt projects.

1. Key Details

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BEFORE completing Incident Reports, you should take THIS training course (https://youtu.be/Wr7sI0qGoJI) . Edit your incident reports on mobile as follows: In-progress reports are located in the Compliance app's "To-Do List". Access and edit/update submitted reports with Safari or Chrome from the event list (refer to training (https://www.youtube.com/watch?v=m1fYqDHezCM) , but via phone instead of computer when it comes to opening events at the 5:40 mark).
Select the party that contributed most/first to the accident. If subcontractor, select "Trade Contractor".
Select the Incident Type based off of the sequence of events.
What was the scope/division of work that caused/contributed to the incident? If a worker fell off a ladder while installing sheet metal flashing on a roof parapet, the appropriate division would be 05 Metals
Released STCKY energy contacted or came within six feet of personnel (or could have)
(reported to Sundt project management)
Not including cranes or utilities
Not including cranes or utilities
(NOT project)
Describe how the incident occurred. Use this GPT for assistance. (https://chatgpt.com/g/g-nT7yZSd9i-ida) Ensure that for injuries, include where treatment was provided (on site, clinic, etc) and what the current work status is (returned to work to tolerance, placed on restricted duty, etc). DO NOT: make statements about how the incident could have been avoided retaliate against injured/affected persons repeat content already inputted thus far like date, time, location, etc.

2. Involved Party #1

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3. Involved Party #1: Injury Details

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Input the more seriously injured party first (if multiple injured)
Input the most severe injury first
REMEMBER TO CALL OCCUCARE FIRST FOR NON EMERGENCY INJURIES INVOLVING SUNDT PERSONNEL 866-268-0884
STCKY Injury - Select SIF criteria from the box below.
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours. https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.39 (https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.39)
Input a single 0 if employee number cannot be obtained
Input date of 1/1/1911 if unknown
Input 1 if unknown

4. Involved Party #2

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5. Involved Party #2: Injury Details

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REMEMBER TO CALL OCCUCARE FIRST FOR NON EMERGENCY INJURIES INVOLVING SUNDT PERSONNEL 866-268-0884
STCKY Injury - Select SIF criteria from the box below.
Input a single 0 if unknown
input today's date if unknown
input today's date if unknown
input a 0 if unknown

6. Equipment, Vehicle, Property #1

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Use the "Crane" section for any crane-related equipment documentation. Use the "Utility Damage" section for utility property damage.
Who is the owner/responsible person for the equipment/vehicle/property?
Company, policy number, ID, insured, etc.
For example: A fiber optic/gas/electrical utility was damaged by construction activities which caused outage for nearby businesses.

7. Equipment, Vehicle, Property #2

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Use the "Crane" section for any crane-related equipment documentation. Use the "Utility Damage" section for utility property damage.
Who is the owner/responsible person for the equipment/vehicle/property?
Company, policy number, ID, insured, etc.
For example: A fiber optic/gas/electrical utility was damaged by construction activities which caused outage for nearby businesses.

8. Equipment, Vehicle, Property #3

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Use the "Crane" section for any crane-related equipment documentation. Use the "Utility Damage" section for utility property damage.
Who is the owner/responsible person for the equipment/vehicle/property?
Company, policy number, ID, insured, etc.
For example: A fiber optic/gas/electrical utility was damaged by construction activities which caused outage for nearby businesses.

9. Crane #1 Information

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10. Crane #2 Information

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11. Utility #1 Damage

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Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

12. Utility #2 Damage

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Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

13. Water Intrusion

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Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

14. STCKY Causal Analysis: S#!t That's Built at Heights

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Walking Surfaces | Stairs | Ramps: Relentless Housekeeping - Access | Egress free from obstructions, tripping hazards Landings of not less than 30 inches Uniform riser height and tread depth No hazardous projections: protruding nails Proper Handrail Installed For more information see: https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1052 (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1052) Ladders – Ladders - Relentless Housekeeping - Access | Egress free from obstructions, tripping hazards In good condition At least a Type 1A (rated for up to 300 pounds) Constructed of nonconductive material Setup at a 4:1 angle Secured | tied off to prevent movement Extend 3ft beyond landing area or have “pass through” gate Protected from fall exposure by means of a controlled access point Be used per the manufacturer’s instructions For more information see: https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053 (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053) Elevated work platform Inspected and maintained Designed for intended use Fall protection system in place

15. STCKY Causal Analysis: S#!t That Stores Energy

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Stored energy identified Line of fire protection in place (PPE, barricading, spacing) Proper safeguards established for release of energy “Zero energy” tested prior to continuing work
Stored energy identified Inspected and maintained Line of fire protection in place (PPE, barricading, spacing) Proper safeguards established for release of energy “Zero energy” tested prior to continuing work
Stored energy identified Designed for intended use Inspected and maintained Line of fire protection in place (PPE, barricading, spacing) Proper safeguards established for release of energy “Zero energy” tested prior to continuing work

16. STCKY Causal Analysis: S#!t That's Built in Confined Spaces

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"Confined space" means a space that: (1) Is large enough and so configured that an employee can bodily enter and perform assigned work; and (2) Has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins, hoppers, vaults, and pits are spaces that may have limited means of entry.); and (3) Is not designed for continuous employee occupancy. "Non-permit confined space" means a confined space that does not contain or, with respect to atmospheric hazards, have the potential to contain any hazard capable of causing death or serious physical harm. "Permit-required confined space (permit space)" means a confined space that has one or more of the following characteristics: (1) Contains or has a potential to contain a hazardous atmosphere; (2) Contains a material that has the potential for engulfing an entrant; (3) Has an internal configuration such that an entrant could be trapped or asphyxiated by inwardly converging walls or by a floor which slopes downward and tapers to a smaller cross-section; or (4) Contains any other recognized serious safety or health hazard.
Air tested to verify no atmospheric hazards present.
Air Monitoring: Confined space air tested prior to entry and monitored during shift with calibrated monitor Adequate ventilation maintained
Safe Access: PPE and equipment for safe entry available Employees properly using entry equipment https://www.osha.gov/laws-regs/federalregister/2015-05-04 (https://www.osha.gov/laws-regs/federalregister/2015-05-04)
Safe Access: Required signage and permitting in place PPE and equipment for safe entry available Employees properly using entry equipment Confined Space Attendant stationed outside during operations https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.146 (https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.146)
Radio or visual means of communication established with entrants tested and verified
Emergency Response: Emergency numbers available Rescue equipment available

17. STCKY Causal Analysis: S#!t That's Built Underground

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Active, refreshed dig ticket Service/lateral lines are located. Existing Utilities are located and marked Potholing used to verify the location and depth of the utility Potholed utilities marked, protected, supported, or removed
Atmosphere within the excavation tested Testing conducted at regular intervals to ensure that the atmosphere remains safe Precautions taken to protect employees from exposure to hazardous atmospheres Emergency equipment readily available Employees trained to use personal protective and rescue equipment
Safe means of access/egress available? Provide safe means of access/egress for workers in trench/excavations 4’ or deeper Provide safe access/egress available within 25‘ of lateral travel Bridges with handrails across trenches wider than 30” Relentless Housekeeping - Maintain access/egress clear of obstructions Install Barricade/Flagging/Fencing 6ft. from leading edge Provide Fall protection available for workers near leading edge Ladders – Access/Egress free from obstructions, tripping hazards No damage on rails or rungs At least a Type 1A (rated for up to 300 pounds) Constructed of nonconductive material Setup at a 4/1 angle Secured/tied off to prevent movement Extend 3ft beyond landing area or have “pass through” gate Protected from fall exposure by means of a controlled access point Be used per the manufacturer’s instructions For more information see: https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053 (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Cave in protection - Excavations 5’ deep or greater have protective system Excavations greater than 20’ designed by professional engineer Spoils, materials, and equipment set back at least 2’ excavation edge Loose rock or soil at excavation face sealed back Accumulation of water controlled Sloping / Benching – Sloping/Benching appropriate for soil classification Type A Soil - ¾:1 If 12’ or less and open for less than 24 hrs. Type B Soil – 1:1 Type C Soil - 1 ½:1 (type C soil cannot be benched) Trench Box or Shield – Tabulated Data on site Box placed to prevent lateral movement Box extends 18” above excavation Box no more than 24” from bottom of excavation Hydraulic Shoring – Tabulated Data on site Horizontal spacing per tabulated data (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)

18. STCKY Causal Analysis: S#!t That's Moves or Crushes

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Equipment logistics plan in place and executed First move forward being utilized Separate access routes for equipment and personnel established Properly trained and positioned spotters (if required) Blind spots identified and protected Crush points identified and protected Ground personnel using positive visual confirmation before approaching equipment (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Traffic control plan in place Equipment/Vehicles positioned to protect workers Workers wearing all required PPE Safe access to work zone available (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Traffic control plan in place Equipment/Vehicles positioned to protect workers Workers wearing all required PPE Safe access to work zone available (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)

19. STCKY Causal Analysis: S#!t That's Hazardous

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SDS available and reviewed Appropriate PPE identified, provided, and in use Spill/emergency response procedures in place (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Project specific procedures for heat illness prevention being followed Ice is available Cool water is available within reasonable walking distance Rehydration drinks/pops/powders available Heat illness kit available Shade provided close to the work area OSHA - Heat Illness Prevention: https://www.osha.gov/heat (https://www.osha.gov/heat) OSHA – NIOSH Heat Safety Tool - Download: https://apps.apple.com/us/app/osha-niosh-heat-safety-tool/id1239425102 (https://apps.apple.com/us/app/osha-niosh-heat-safety-tool/id1239425102) (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)

20. STCKY Causal Analysis: S#!t That's Energized

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Rated for intended use Cord insulation intact Properly grounded
Rated for intended use Grounded and/or functional GFCI Conductors insulated or protected from contact
Correct PPE provided for operation Work performed by qualified person Hazardous or residual energy identified and locked out System/Equipment has been “zero energy” tested prior to work

21. STCKY Causal Analysis: S#!t That Lifts

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Underground hazards identified and marked Ground rated for load Ground conditions firm, drained, and graded Outriggers extended as required by load chart Floats level, cribbing/matting sufficient Swing radius protection in place
Overhead Utilities: For work near powerlines: All of the following must be met: Planning meeting (discuss de-energizing lines) Signs and barricades Non-conductive tag lines Warning lines erected Spotter required Encroachment Precautions for operations up to 350kV: At Least One of These Additional Measures Proximity alarm Range control warning device Range control prevention device Insulating link Table A – Minimum Powerline Clearance Distances – Operation Voltage Distance 0 to 50 kV 10 ft 50 to 200 kV 15 ft 200 to 350 kV 20 ft 350 to 500 kV 25 ft 500 to 750 kV 35 ft 750 to 1000 kV 45 ft
Known weight of load Known Capacity of load handling equipment Anti-Two-Block Functional Rigging inspected and adequate for task Controlled lift zone Tag lines Designated signal person Qualified rigger Overhead load alert
Ground conditions sufficient for task Outriggers extended as required by load chart Lifting equipment level during lift Spotter or C.A.Z in place as needed Using manufacturer approved lifting points
Overhead Utilities (OLHD): Encroachment Precautions for operations up to 350kV: All of the following must be met: Planning meeting (discuss de-energizing lines) Signs and barricades Non-conductive tag lines Warning lines erected Spotter required Table A – Minimum Powerline Clearance Distances – Operation Voltage Distance 0 to 50 kV 10 ft 50 to 200 kV 15 ft 200 to 350 kV 20 ft 350 to 500 kV 25 ft 500 to 750 kV 35 ft 750 to 1000 kV 45 ft
Known weight of load Known Capacity of load handling equipment Rigging inspected and adequate for task Controlled lift zone Tag lines as required Designated signal person as required Qualified rigger as required

22. Causal Analysis - Safeguard Review

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Ask these questions about the person who was most involved in the incident.
Example - A new construction material was installed using typical practices for other materials.
For example- The task's JHA did not identify a critical step.
Do we actually know why the person chose to do what they did?
What was the scope/division of work that caused/contributed to the incident? If a plumber doing roof drains fell over a roof parapet that was shorter than guardrail height, the Division would be roofing which is 07 Thermal and Moisture Protection (not plumbing)

23. Attachments, Documentation, Photos

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Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

24. Misc Details

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If incident was an inspection by a regulatory agency, list the personnel who participated in the inspection process.
Select internal participants here. For personnel not listed, use the next field.
Type out any other participants' name & company.
Regulatory / Responding agencies (i.e., OSHA, Police Dept, Fire Dept, etc)

25. Authorities

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26. Inspection by Regulatory Agency

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Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Be sure to take the same photographs from the same angle as the inspector
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

27. Inspection by Regulatory Agency - Citation #1

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i.e., OSHA: 1138192.015

28. Inspection by Regulatory Agency - Citation #2

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i.e., OSHA: 1138192.015

29. Inspection by Regulatory Agency - Citation #3

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i.e., OSHA: 1138192.015

30. Citation #1

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i.e., OSHA: 1138192.015
i.e., Other than serious

31. Citation #2

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i.e., OSHA: 1138192.015
i.e., Other than serious

32. Citation #3

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i.e., OSHA: 1138192.015
i.e., Other than serious

33. Witnesses

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If additional witness statements need to be inserted, this section can be duplicated-- click on "Copy Section". Interview Guidelines (https://www.csra.colorado.edu/_files/ugd/92d978_ffa43ea8f74a4ea383cd4b954414e4b2.pdf?index=true)
Use a computer to download the witness statement in Word format
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Sample questions to ask if needed: When did the incident occur (date and time)? How was the task planned? Was there a THA or work plan for this operation? Was the THA being followed as written? Where were you when the incident occurred? Where were others located when the incident occurred? Did others witness the incident? Do you know their names? What events occurred just before the incident? When was the incident/leak/problem realized? How far along in the operation were you when the incident occurred? How did the incident occur / What happened? What equipment, material, or personnel were involved? Where was the equipment, material, tool? Where was the machine in its cycle? Who installed the equipment? What was damaged? Who and what was injured? What happened after the incident? How could this be prevented from recurring? How are you connected with others involved in the incident? Would you like to provide any additional information?

34. Contact

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35. STCKY Classification

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Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
An incident must only have one official classification.

36. Incident Review Level

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After completing the fields on the report, the Incident Level will populate accordingly.
An incident must only have one official Level.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

37. Submit

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38. Compass Data Centers - Additional Required Info

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For example, "arc flash"
For example, " While performing L4 for PC 1F2 MSB an Arc flash Occurred"
For example, " ARC Flash during L4 on PC 1F2 MSB"
For example: 1.Wire removed for relocation of terminal block for better access of EC on site. 2. Terminal block mounted too low on some units which made termination difficult. 3. The block mounting location not specified on any drawing.
For example, "Wire strands crossed phases on terminal block when relocated to accommodate the connection from the bottom."
For example, 1. Review all GPZ Comm box for similar issues.      SE site team   In progress 2. Rework the comm box, replace wiring, terminal block, and breaker.      SE site team Complete 3. Update terminal block mounting location on drawings.      SE pre-fab engineer ongoing due 11/1/25 4. Review oversight and validation of contractor scope of work. Documentation to include inspection records.

39. Project-Level Incident Review Meeting

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Incident Review Meeting & Attendees (via Teams) schedule within 48 hours of the incident hold meeting within two weeks of incident send calendar invite to Review Mtg Attendees Subject line of invite: Level X Incident – Incident Type – Group Level 1 (Optional) • Project Team & Executive • Regional Director • District/Group Safety Manager Level 2 – Level 1 plus: • District Manager & Group Manager • Paul Levin Level 3 - Level 2 plus: • Mike Hoover, CEO
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

40. Sundt Leadership - Incident Review Meeting

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Incident Review Meeting & Attendees (via Teams) schedule within 48 hours of the incident hold meeting within two weeks of incident send calendar invite to Review Mtg Attendees Subject line of invite: Level X Incident – Incident Type – Group Level 1 (Optional) • Project Team & Executive • Regional Director • District/Group Safety Manager Level 2 – Level 1 plus: • District Manager & Group Manager • Paul Levin Level 3 - Level 2 plus: • Mike Hoover, CEO
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

41. Revision Log

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Input details on what was edited... Provide the date of changes and list the changes that were made. Add to this section as additional updates are made to the report (don't delete previous revision details). Examples of revisions to detail: Added attachments Corrected errors Documenting incident review meeting Re-classifying the incident Updating data related to worker compensation etc

42. Insurance / Claims Info

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